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Original research
Changes in aortic valve replacement procedures in Denmark from 2008 to 2020
  1. Peter Laursen Graversen1,
  2. Jawad Haider Butt1,
  3. Lauge Østergaard1,
  4. Andreas Dalsgaard Jensen1,
  5. Peder Emil Warming1,
  6. Jarl Emanuel Strange1,
  7. Christian H Møller2,3,
  8. Morten Schou3,4,
  9. Ole De Backer1,
  10. Lars Køber1,3,
  11. Emil Loldrup Fosbøl1
  1. 1Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
  2. 2Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
  3. 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
  1. Correspondence to Dr Peter Laursen Graversen, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark;{at}


Introduction Since 2007, transcatheter aortic valve implantation (TAVI) has emerged as another treatment strategy for severe symptomatic aortic stenosis (AS) compared with surgical aortic valve replacement (SAVR). The objectives were to compare annual rates of aortic valve replacement (AVR) procedures performed in Denmark in the era of TAVI and to assess proportion of AVRs stratified by age with use of age recommendations presented in current guidelines.

Methods Using Danish nationwide registries, we identified first-time AVRs between 2008 and 2020. Patients who were not diagnosed with AS prior to AVR were excluded

Results The rate of AVRs increased by 39% per million inhabitants from 2008 to 2020. TAVI has steadily increased since 2008, accounting for 64.2% of all AVRs and 72.5% of isolated AVRs by 2020. Number of isolated SAVRs decreased from 2014 and onwards. The proportion of TAVI increased significantly across age groups (<75 and ≥75 years of age, ptrend<0.001), and TAVI accounted for 91.5% of isolated AVR procedures in elderly patients (aged ≥75 years). Length of hospital stay were significantly reduced for all AVRs during the study period (ptrend all<0.001).

Conclusions The number of AVRs increased from 2008 to 2020 due to adaptation of TAVI, which represented 2/3 of AVRs and more than 70% of isolated AVRs. In elderly patients, the increased use of AVR procedures was driven by TAVI, in agreement with the age recommendations in current guidelines; however, TAVI was used more frequently in patients aged <75 years, accompanied by a flattening use of SAVR.

  • aortic stenosis
  • transcatheter aortic valve replacement
  • epidemiology
  • heart valve prosthesis implantation
  • heart valve diseases

Data availability statement

No data are available.

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  • Contributors PLG in collaboration with ELF and LK contributed to planning, conducting and reporting this manuscript. All authors performed data acquisition, analysis or interpretation. All the authors contributed critically to the revision of the manuscript for important intellectual content. PLG performed the statistical analyses. ELF, JHB and LØ aided with the data management and statistical analyses. ELF provided general supervision throughout the process. PLG and ELF are the guarantors of the content in the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PLG: Independent research grant provided by the Novo Nordisk Foundation for research in valvular heart disease. However, the foundation did not have any influence on the study design, data acquisition, data analysis or preparation of the manuscript. Neither had it any effect on the publication process. JHB: reports advisory board honoraria from Bayer, outside the submitted work. MS: Lecture fee Novo, Novartis, Bohringer Ingelheim and Astra Zeneca. ODB: received institutional research grants and consulting fees from Abbott and Boston Scientific. LK: Speakers honorarium from Nova, Novartis, AstraZeneca, Bayer and Boehringer, unrelated to this manuscript. ELF: an independent research grant provided by the Novo Nordisk Foundation for research in valvular heart disease.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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